Borderline Personality Disorder

Around five million people with borderline personality disorder (BPD) are estimated to be living in the United States. Personality disorders are characterized by ways of seeing and reacting to others that can cause interpersonal and behavioral problems in life and relationships. Common signs of borderline personality disorder, in particular, include emotional instability and difficulty maintaining healthy connections with others. People with this condition may feel happy and positive and then sad and depressed a few hours later. Learning more about the treatments available for borderline personality disorder, such as dialectical therapy, may help you make an informed decision on your mental healthcare.

What is borderline personality disorder (BPD)? 

A 2018 study suggests there are common risk factors believed to lead to borderline personality disorder. Neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma may put you at a higher risk.

What causes BPD? 

A 2018 study found that common factors believed to lead to BPD included brain abnormalities, genetic and environmental factors, and a history of childhood trauma. In addition to these factors, there are several other potential causes of borderline personality disorder (BPD) or emotionally unstable personality disorder. These factors may contribute to the development of the disorder:

• Genetic predisposition: A family history of borderline personality disorder (BPD) or other disorders can increase the likelihood of developing the condition.
• Brain abnormalities: Changes in brain areas related to emotional regulation may contribute to emotionally unstable personality disorder.
• Childhood trauma: Early exposure to trauma, such as neglect or abuse, is a significant risk factor for borderline personality disorder (BPD).
• Environmental stressors: Ongoing stress or adverse life experiences can trigger emotionally unstable personality disorder.
• Unstable relationships: Difficulty in early relationships, especially with caregivers, may influence the development of borderline personality disorder.
• Emotional dysregulation: Challenges in regulating emotions and coping with emotional distress are common in individuals with borderline personality disorder.
• Attachment issues: Insecure attachment styles in childhood may lead to the development of emotionally unstable personality disorder.
• Socioeconomic factors: Experiencing financial instability or growing up in poverty can be linked to the development of borderline personality disorder.
• Poor coping mechanisms: Ineffective coping strategies during childhood or adolescence can increase the risk of borderline personality disorder.
• Neurobiological factors: Abnormalities in neurotransmitter systems, such as serotonin, may be involved in emotionally unstable personality disorder.

How is Borderline Personality Disorder (BPD) diagnosed?

Borderline personality disorder is often diagnosed and treated after age 18. This is because an individual’s personality typically evolves so significantly throughout childhood and adolescence that providing an accurate diagnosis of a personality disorder in these phases of life can be difficult. Many children or teens who will go on to receive a borderline personality disorder diagnosis as adults may be initially diagnosed with depression or anxiety disorders in their younger years. A licensed mental health professional can diagnose the condition through interviews and observations of both the individual and family history. In some cases, other disorders, such as mood disorders or anxiety disorders, may also be considered during the diagnostic process to rule out overlapping symptoms.

Common symptoms of borderline personality disorder (BPD) and other mental health conditions

Therapists and psychiatrists typically look for the following symptoms when considering a diagnosis of borderline personality disorder and other mental disorders:

• A fear of abandonment
• Emotional pain related to actual or imagined loss of significant relationships 
• Unstable emotions and/or challenges controlling intense emotions 
• Unstable self-image 
• Traumatic life events 
• Intense and unstable relationships with friends and family members
• Self-destructive relationship habits 
• Difficulty holding a job for an extended period
• Risky, impulsive behavior like unsafe sex or uncontrolled spending
• Self-harm 
• Suicidal thoughts
• Difficulty managing stress
• Intense anger and/or irritability 
• Dissociation (feeling "out of your body") 
• Rapid mood swings 
• Significant stress-related paranoia 
• Ongoing feelings of depression or anxiety 
• Feeling persistently bored or empty 
• Challenges understanding one's identity or personality 
• Cycling patterns of recognizing and denying the value of one's relationships often referred to as "splitting"

Co-occurring conditions with borderline personality disorder (BPD)

Developing borderline personality disorder (BPD) may also occur alongside another mental health condition, including the following:  

• Anxiety disorders 
• Post-traumatic stress disorder (PTSD) 
• Complex post-traumatic stress disorder  (C-PTSD) 
• Sleep disorders 
• Eating disorders, including binge eating
• Depression 
• Substance use disorders
• Suicidal behavior
• Bipolar disorder
• Narcissistic personality disorder (NPD) 
• Psychotic disorders

What treatments are available for BPD?

Psychotherapy, or talk therapy, is considered the cornerstone of BPD treatment according to the National Alliance on Mental Illness (NAMI). A comprehensive health treatment plan for borderline personality disorder may include a combination of psychotherapy and specific work to repair social factors alongside a clinical social worker or other mental health professionals. For individuals with co-occurring mood disorders or anxiety disorders, additional therapeutic approaches may be recommended to address these conditions as well. A mental health provider may also recommend medication to help manage severe symptoms for some disorders. Do not start, stop, or change any medication without consulting a psychiatrist or other healthcare provider who can manage your psychiatric management plan. Types of therapy that are commonly recommended for those who develop borderline personality disorder (BPD) are listed below.

Borderline personality disorder is often treated through DBT, which is a form of cognitive-behavioral therapy (CBT) focused on the impact of your beliefs, thoughts, and behaviors, emphasizing mindful living and acceptance to manage symptoms. This type of therapy (DBT) is usually a structured program that involves a workbook, worksheets, and frequent sessions. For individuals who experience co-occurring anxiety disorders or mood disorders, DBT can be adapted to address these additional challenges in combination with BPD. It can be done in an individual or a group therapy format and was developed specifically to treat borderline personality disorder by Dr. Marsha Linehan. It involves four modules, including:

• Emotional control
• Distress tolerance 
• Mindfulness skills
• Interpersonal effectiveness

The authors of a journal publication on DBT for borderline personality disorder state that "dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for borderline personality disorder (BPD). Randomized controlled trials have shown the efficacy of DBT not only in borderline personality disorder but also in other disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders."

Borderline personality disorder (BPD) symptoms may lead to distress within a family dynamic. Family therapy can be a potential long-term therapeutic plan for individuals such as parents, siblings, partners, or mothers with borderline personality disorder who often feel emotionally unstable and experience difficulty maintaining healthy relationships. Through family counseling, individuals with borderline personality disorder and their immediate family can meet with the therapist together to discuss behavioral and emotional interventions and learn healthy coping skills and communication strategies.

Schema therapy can be effective for people with other personality disorders who may not respond to other treatments as it’s a combination of elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, or a pattern of unwanted thoughts, to reduce self-destructive personality behaviors that may have developed during childhood. This therapy may also be helpful for individuals with anxiety disorders, as it addresses deep-rooted emotional patterns that contribute to these conditions.

Cognitive behavioral therapy is backed by significant research suggesting its effectiveness in treating various mental health conditions, including borderline personality disorder (BPD). This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to shift them. 

Researchers believe that TFP treatments may help those with borderline personality disorder (BPD) who experience a split optimistic and pessimistic view of themselves and their primary caregiver due to excessive childhood aggression. TFP aims to merge the positive and negative perspectives of personality to form a realistic view of the self and others.

Coping with BPD

In addition to working with your mental healthcare provider to develop a plan to treat specific symptoms, there are various coping skills and lifestyle changes you might use to manage your symptoms and adjust to living with borderline personality disorder (BPD), including the following:

• Journaling
• Building distress tolerance
• Practicing mindfulness
• Identifying accountability 
• Working self-focused time into your routine
• Practicing yoga or other forms of calming movement 
• Distracting yourself with sensory stimulation
• Not assuming intentions
• Caring for your physical health
• Taking walks in nature

Tips for supporting a loved one with BPD

If someone you love has been diagnosed with borderline personality disorder, there are several ways you can support them, including the following:

Learn about borderline personality disorder

If your family or partner has borderline personality disorder, attending family or couples therapy together could help strengthen your bonds and teach you both helpful coping strategies for communication, connection, and crisis response. 

In the end, it’s the choice of the individual with borderline personality disorder whether or not to attend therapy or seek other treatments for their condition. However, it could be beneficial for you as their loved one to gently encourage them to seek or stick with treatment long-term. Knowing that they have your support through the process could help them start or stay the course.

Finding a balance between supporting your loved one and caring for yourself can be crucial. This can look like setting and enforcing boundaries related to your space, belongings, body, and time. for one. If you feel you could benefit from support with this or another aspect of loving someone with borderline personality disorder, speaking to a therapist yourself may be beneficial.  

Counseling options for mental health

If you experience trouble maintaining healthy relationships, feelings of emptiness, an intense fear of abandonment, poor impulse control, and/or other symptoms of borderline personality disorder, you might consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, online counseling for BPD could represent a more convenient option.